Mental disorders aren't necessarily valid

Great Debates
221

Keep in mind, however, that certain mental illnesses also affect the same part of the brain involved in decision-making. As a person with mental illness (sometimes worse than at other times) I am aware that I am not always in a position to make a reasonable analysis of my state of health.

From the inside, the illness feels normal. A depressed person, for example, could be planning suicide and never dream that he might merely have a seratonin imbalance in the brain. He might see his plan as a perfectly rational solution when it is not.

Further, many people who have had depression in their lives before, don’t recognize it when it happens again. The illness distorts the ability to perceive accurately.

The brain is not very reliable in making judgments about itself.

Fortunately, most of the psychiatrists I have known have been so exposed to extremes in behavior that they are not disturbed or fooled by merely eccentric behavior. Your family may think you are crazy because you wear a feather boa and sing Zippity Doo Da as you walk to work – but a good shrink won’t assume anything from that behavior.

So they come to see you in a manic stage but they don’t start therapy until they become depressed? 25% of your patients become depressed after coming to see you?

Or is this in retrospect that they say that they had been “manic” and then suddenly became depressed and began therapy with you? If so, who were they denying their depression to?

Bizarre.

222

Oh, please. The concept of a “serotonin imbalance” is ridiculous.

First of all, the brain is extremely good at compensating for gross alterations in its neurochemistry. Individuals vary greatly in their average normal levels of neurotransmitters, and humans adapt quickly to forced changes in chemistry. That’s precisely why heavy smokers can ingest enough nicotine to kill an unexposed human, why opiate abusers aren’t even affected by a dose sufficient to knock out normal people, and why more than 90% of the neurons in the substania nigra can die before the diagnostic symptoms of Parkinson’s Disease appear.

Secondly, reduced levels of serotonin don’t cause depression. It’s been tried, by administering drugs that interfere with serotonin synthesis, administering drugs that interfere with the production of lots of neurotransmitter amines, and by restricting diets to reduce the levels of serotonin precursors. It doesn’t make people depressed, with the exception of a few people who had a previous history of depression.

Thirdly, Zoe, are you truly incapable of recognizing that your attribution of people’s behaviors to a disease is nothing more than a way to induce people to think about their opinions differently?

223

Sure, I would like to see people with uninformed opinions be able to reason from a place of enlightenment. Isn’t that what the Straight Dope is about? But you are not totally correct in saying that I attribute people’s behaviors to a disease. Certain behaviors in people with mental illnesses can be attributed to their diseases.

I really do like to be precise and that seems to be part of the problem that we have in communication. I write something precisely, you generalize from it and then respond to the generalization as if I had said it.

Up-to-date sources of information should be valuable in helping the lay person to understand that insights into mental illness have been greatly changed by new technologies.

For example, this research study is hot off the press:

http://www.dbsalliance.org/Headlines.html

Here is an excerpt:

[quote Brain imaging helps to understand depression

24-Oct-03 - NewsRx.com

Around 5 million people in the U.K. experience depression at any one time. While a number of successful treatments, both pharmacological and psychotherapeutic, are available and many people make a full recovery, about 30 - 40% of people are resistant to conventional therapies.
Now an international team of researchers have discovered that brain activity differs significantly between healthy individuals and those suffering from treatment-resistant clinical depression.[/quote]

The complete article explains a little more and I assume the full documentation results are published in professional journals or will be soon.

Perhaps it is a major step toward finding help for those who have been treatment resistant.

224

Electric!sheep,

While I disagree with most of your POV, I will criticize the DSM approach on one count that overlaps a little with your position. Take a particular smart child with a particular objective amount of inattention and impulsivity. Put into two very different homes: one a family that is highly invested in education and anxious in a very attentive school system that has high expectations; another with very low key parents and not a great school. The child might very well be percieved as “handicapped” by his inattention in setting one and not in setting two. In one, his parents know that he is smart, and “should” be an A/B student, but isn’t because he doesn’t focus. In the other his smarts are enough for him to get C’s and his parrents are laid back about the disorganization and rambunctiousness.

This is a problem when one is trying to establish incidence and contributing factors to the biological basis of the disorder.

Now from my POV I have only those subjective judgements to go by. The school, the parents, and other involved caretakers. And the child if old enough, and the parents as the childs legal and ethically correct decision makers, make the call as to what is handicapping. And if any treatment, let alone medication, is needed.

225

How many medical diseases rely on subjective judgments for diagnosis?

Are there many other conditions which you would feel comfortable diagnosing without any objective criteria (physiological symptoms, lab results, etc.)?

226

Most. Most diagnoses rely on subjective.

Colds, flus, headaches, bronchitis, asthma, pneumonia (even reading the CXRay is a subjective excercise, reading mammograms for breast cancer screening is subjective interpretation, even judging the degree of atypia on pathological slide samples is subjective.

The vast majority of diagnoses are based on history, history, history. Exam less so. Labs only to verify or to potentially disprove your diagnosis in some cases.

227

Let me rephrase that: how many rely exclusively on subjective measures?

Plenty of those conditions can be diagnosed with expert systems (they’re particularly good at finding cancerous growths in X-ray images).

228

Alzheimer’s disease. Definitive diagnosis made postmortem.

229

Ah, but we can verify that our associations of certain symptoms with Alzheimer’s are valid through objective means.

How many conditions rely entirely and completely on subjective measures, having no empirical definition at all?

230

Not until after death.

Your question was, “How many medical diseases rely on subjective judgments for diagnosis?” Modified by the addition of exclusively.

Alzheimer’s disease does fit this criteria. We are talking about living patients with some perceived disorder. Diagnosis and management of AD, especially in the early stages, are based solely on subjective measures. Alzheimer’s is a diagnosis by exclusion – rule out other known causes of dementia and what is left is a presumptive diagnosis of AD, verified (or not) by brain tissue studies after death. Symptomology and lack of positive results to lab/imaging/culture tests for disease processes that can cause the same symptoms are the bases for diagnosis. Enhanced imaging and enzyme assay are being evaluated, but are not currently part of the screening process.

231

And many mental diseases have pathologic findings associated with them (fMRI findings etc.)

Also many other diseases that now have some objective measuring device associated with them, had no such measure for many years of study. They were no less scientifically studied; the scientific study in fact drove the development of the devices in a nonlinear fashion.

I would agree, have agreed, that the reliance on subjective measures for diagnosis makes the scientific study of mental illness inherently more of a challenge. Where we persistently disagree is how to respond to that challenge.

232

But Alzheimer’s, for example, has clear and rather obvious pathological findings associated with them. Most mental disorders don’t – there are some weak trends that fall within the normal range of variation and some anomalies that vary unpredictably from subject to subject.

I’m sorry, but you can’t just point to the evidence and then suggest that it’s of the same breadth, depth, and quality as the evidence for other conditions.

Of course, Alzheimer’s is probably a poor example, then, since we can’t explain why many normal people have seemingly high levels of neurofibrillary tangles and plaques. [shrugs] Still, it’s painfully clear that there’s something physically wrong in AD, but that simply isn’t the case with many mental disorders. In some others, it seems clear that at least some of the people diagnosed with the condition have some physiological problems, but the nature and cause of those problems is not well-understood.

233

WHY is it “painfully clear”? How is dementia so different from most of the other conditions that we’ve discussed? Other than that scientific study has progressed a little farther?

234

Speaking as a person diagnosed (at various times):

• paranoid schizophrenic
• manic-depressive (aka bipolar disorder)
• various personality disorders,e.g., schizotypal, borderline, schizoaffective…

AND speaking TO a movement comprised of people who have psychiatric diagnoses themselves, all of us brought together to fight forced treatment and try to raise public awareness of the problem of forced treatment and fully informed consent (i.e., expose the lies told about various psychiatric treatment and their specificity and reliability and cure rates etc) –

I have said and I continue to say that I think it is a WASTE OF TIME to argue that mental illness does not exist, that the entire medical model of mental illness is founded on etiological quicksand and the bad history of institutional psychiatry and its rationale.

I have said and I continue to say that in trying to make that point and win hearts and minds over to us through the making of that argument, we are pitting ourselves against licensed medical doctors (psychiatrists and, to a lesser extent, the larger medical establishment of which they are a part) and the pharmaceutical industry and all of their laboratories. “We”, keep in mind, are the psychiatrically diagnosed, and most of us don’t have those degrees; we have few credentials indicating that we are qualified to speak about neurotransmitters and their uptake and inhibitors thereof and the sensitivity of receptors here and the speed of enzyme release there and the threshold of synaptic response subsequent. “They”, keep in mind, are NOPE they are NOT the doctors and pharma companies, THEY are our intended AUDIENCE, the hearts and minds we’re supposed to be trying to win over, remember? THEIR eyes are glazing over in the wash of details and so: do they believe the credentialed bio-background people with the labs, or do they believe us? That’s right, my fellow lunatics, it doesn’t matter if we’re right, it doesn’t matter if we spend our weekends cramming our heads with organic chem just so as to be able to wade through medical journals and be ready to argue the point. It doesn’t fucking matter. We ain’t gonna win this one.

And I have said and continue to say that a tactical retreat to a much better position is in order.

Grant them (and our listening audience, the ones with the hearts and minds etc) that there is a “difference”. This thing they call “mental ilnness”, that they say sets us apart from the rest of the world, this biological difference-in-the-brain. We don’t have to believe it but we can adopt the tactic of saying “Yeah, so we’ve heard”.

Then we say: “So? The existence of a difference, whether biological or cultural, doesn’t make it an illness”. My fellow nutcases, guess what? All the laboratory evidence in creation can’t define a condition as an illness, especially when it comes to human behavior. Now we’re in the realm of politics, of identity politics and, better yet, in an already-politicized area of identity politics in which it has been well-argued and partially established and socially accepted that minorities have the social and cultural right to embrace their differences and not be changed and not be discriminated against. Thank god for gay folks. Shall we walk in the path that they have blazed before us?

And we say: “Look, over here, we like the way we are and we don’t want to change and we don’t want to be changed”. And we have schizzy pride marches. And we encourage bipolar folks to come out and be overt about their mood swings and instead of trying to hide our extremes we grade ‘normal’ folks as tolerant or intolerant based on the extent to which they only accept us as long as we act ‘normal’. And we speak of hiring quotas and inclusion in hate crime legislation and we ask every politician what he or she has done for us and our rights lately.

This is how to do identity politics in America, my crazy friends.

Let them chase neurotransmitters, for we have better things to do. Like ending forced treatment and stigma.

235

DSeid: you’re joking, right? Alzheimer’s is associated with gross neurological damage, its mental symptoms correlate strongly with the degree of neurological damage that can be detected, and there is simply no indication of psychological factors causing the condition.

AHunter3: does that matter? I don’t particularly care about the politics of mental health care. I do care that a very successful Big Lie has spread itself into the general consciousness and is maintaining itself because of irrational needs.

Politics is irrelevant. Truth is what matters.

236

AHunter, and would fully support your rally against forced treatment (with the rare exception of iminent danger to self or others)

TVAA, Before the neuropathology was identified Alzheimers was a clinical diagnosis without a test, without a known cause, clinically seperated from otherdementias only clinically, no clear seperation between confusion and dementia, so on. Making the clinical descriptor alllowed for the study.

237

TVAA, there is sufficient political emotional and economic investment in the belief you call the Big Lie that as long as the available data can be arranged so as to support even a farfetched interpretation in support of it, it will continue to be be maintained quite well because of those irrational needs. But more power to you if you don’t mind the sensation of brick-wall impact against the top of your head, or the shoulder-wrenching jerk of lance caught in windmill blade.

Keep in mind that even if you get a research budget, the procedural form of scientific inquiry is simply not geared towards proving the nonexistence of anything. You’re pretty much stuck with controlling for it as an explanatory variable and attempting to show that in every case its explanatory power goes to zero if you control for other factors that can explain and predict behavior.

DSeid, a reasonable legislative clause ought to be able to provide for the emergency administration of mind-disabling medication whenever anyone is an immediate danger to self or others without needing to reference mental illness one way or the other, right?

238

Alzheimer’s had a well-defined progression of mental degeneration, usually occurred only in individuals of a certain age, and was sufficiently distinguishable to be given a specific name.

I’ve seen the differences between the brains of people who died with advanced Alzheimer’s and normal brains. It’s clearly visible to the naked eye.